Healthcare Provider Details

I. General information

NPI: 1184690737
Provider Name (Legal Business Name): STEPHEN L. YAVELOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W ROBERTSON ST SUITE 108
BRANDON FL
33511-4934
US

IV. Provider business mailing address

721 W ROBERTSON ST SUITE 108
BRANDON FL
33511-4934
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-4221
  • Fax: 813-653-2442
Mailing address:
  • Phone: 813-684-4221
  • Fax: 813-653-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0044136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: